Healthcare Provider Details

I. General information

NPI: 1114296951
Provider Name (Legal Business Name): RETIKA SEHGAL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 400
SAN DIEGO CA
92108-5724
US

IV. Provider business mailing address

3811 COLINA DORADA DR APT 207
SAN DIEGO CA
92124-3806
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-0800
  • Fax:
Mailing address:
  • Phone: 516-974-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number007778-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: